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Permission is granted to reprint for noncommercial educational purposes with acknowledgment. HE0503 New Jersey Department of Education 2014 Pursuant to P. Does anyone in your family have hypertrophic cardiomyopathy Marfan syndrome arrhythmogenic right ventricular cardiomyopathy long QT syndrome short QT syndrome Brugada syndrome or catecholaminergic polymorphic ventricular tachycardia 49. Preparticipation Physical Evaluation HISTORY FORM Note This form is to be lled out by the patient and...
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